August 2017 Trauma Case Study

HPI

You are working for a rural service and are dispatched to a stretch of interstate highway for a motor vehicle accident. While en route to the call, dispatch advises that multiple callers are reporting possibly 2-3 victims trapped inside a car that is completely engulfed in flames. You are dispatched as the second unit to the accident to assist the initial crew. You find one vehicle off the roadway approximately ten feet down an embankment. The car is burned beyond recognition and unable to tell extent of body damage to the vehicle. One victim was found ambulatory on the scene and was taken to the first arriving ambulance for care.

A 30ish year old male is found lying supine on the stretcher. Pt is alert and oriented and yelling that he is going to die.

Has charred face and hair; soot noted in the patient’s nares and oral cavity.

Has blanched white skin around his ears, eyes, nose, and mouth.

Second degree burns noted to chest and lower extremities bilaterally; has what appears to be “blast injury” to both hands and is missing digits on both hands. Skin has sloughed off and bone ends exposed. Bleeding is controlled and clotted off.

Airway is mostly clear upon initial assessment, however, wheezing is noted at this time

INTERVENTIONS

Pt has 18g IV’s established in bilateral AC’s.

100mg of Succinylcholine and 20mg Amidate administered for RSI

No ET intubation attempts were made and KING-LTD placed and secured.

VITALS

B/P: 130/82

HR: 118.

ETCO2 shows good wave form at 35.

Clear and equal lung sounds in all fields

TRANSPORT/HANDOFF

Transported emergently to local community hospital approximately ten minutes away to wait for air-medical transport.